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General NPI Number Information
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NPI Number | 1063558666
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Entity Type | Organization
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Legal Business Name | CON-40 WELLNESS CENTER INC.
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Dates
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Enumeration Date | 01/30/2007
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Last Update Date | 06/21/2012
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Provider Practice Location Address
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Address Line | 10935 N DALE MABRY
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City | TAMPA
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State | FL
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Zip | 33618-4112
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Country | US
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Telephone | 813-969-2225
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Fax | 813-960-3176
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Provider Business Mailing Address
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Address Line | 10935 N DALE MABRY
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City | TAMPA
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State | FL
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Zip | 33618-4112
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Country | US
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Telephone | 813-969-2225
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Fax | 813-960-3176
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Authorized Official
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Title or Position | DIRECTOR
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Name | DAMIEN E ROGERS
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Credential | DC
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Telephone | 813-969-2225
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | CH8355
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License Number State | FL
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